Tuberculosis among Urban Aboriginals in Montreal

BACKGROUND: Aboriginals who migrate to cities continue to have many of the health problems seen in their respective communities. While the incidence of tuberculosis (TB) disease has been dropping steadily over the past several decades, aboriginal peoples still have rates almost five times higher than the Canadian population as a whole. The prevalence of latent tuberculosis infection (LTBI) is high in aboriginal communities compared to Canadian-born non-aboriginal people and it is likely that TB will remain a major problem in the aboriginal population for the foreseeable future. Urban Aboriginals are known to harbor many risk factors known to increase progression of LTBI to disease such as diabetes, HIV infection and substance abuse. In the census metropolitan area of Montreal, Aboriginals represent approximately 0.4% (15,000) of the total population. In 2002-3, five cases of pulmonary TB were diagnosed among the Montreal aboriginal population and all were linked epidemiologically through DNA fingerprinting. This launched an extensive contact investigation and created concern among the urban aboriginal community of Montreal.

OBJECTIVES:

1. To perform over a period of 18 months, screening procedures to determine the prevalence and predictors of latent tuberculosis infection in a sample of urban aboriginal peoples attending or receiving services from the Native Friendship Centre of Montreal (NFCM);
2. To use of a pre-validated questionnaire to determine the current state of knowledge and perceptions about tuberculosis and perform a qualitative component addressing conceptions that may influence patient behavior and compliance in a sample of urban aboriginal peoples attending the NFCM.

METHODS:

• Recruitment: The pool of participants will consist of a sample of individuals over 16 years of age visiting or employed or receiving services including off-site services offered to marginalized populations by street workers. Individuals will have to be of First Nation or Inuit decent.
• Data Collection: Baseline demographic data and self-perceived knowledge about TB including the best ways to disseminate TB information will be determined using a standardized survey instrument and a qualitative component addressing conceptions that may influence patient behavior and compliance. Subjects will be interviewed face-to-face. For those referred to the MCI and found eligible for LTBI treatment, all initial and subsequent visits to the clinic will be compiled on a separate sheet within the medical file. Data on predisposing medical conditions (including HIV status) and other risk factors (homelessness, injecting drug use, smoking)will be collected as well as the number of active TB cases (if any), and completion of therapy.

OUTCOMES TO BE ASSESSED:

1. Prevalence of tuberculin reactors.
2. Proportion of TST reactors identified as such who: a) report to the MCI for medical evaluation; b) are placed on preventive therapy by a physician and c) complete such therapy. Predictors of a, b, and c will be determined.
3. General TB knowledge and perceptions will be evaluated in terms of subsequent patterns of adherence to therapy.

RELEVANCE AND IMPACT: We hope to be able to determine the prevalence of LTBI as well as the knowledge base concerning the perception, etiology, transmission, risk factors, symptoms and treatment of tuberculosis. This information will provide the foundation for future targeted community-based tuberculosis education and prevention programs and thus become an important component of the control of this disease.

For more information on this project, please contact Mary Ellen Macdonald.